Care Home: Longlands

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What the care home does well Prospective service users and their representatives are encouraged to visit the home before making a decision to move into the home for a trial period. The healthcare needs of service users are fully met. Service users were clear about the complaints procedure and said that they would speak to the manager or the person in charge at the time. Recruitment procedures are robust. Staff are well trained and are able to carry out their roles with confidence. The home is run in the best interests of the service users.LonglandsDS0000013158.V376355.R01.S.docVersion 5.2 What has improved since the last inspection? In September 2008, Sharon Fenn was registered with the commission as manager. Since June 2008 the night staffing levels has increased to three care staff. The good practice recommendations made at the last inspection have been addressed. What the care home could do better: Following the inspection we received an action plan from the manager, Sharon Fenn, detailing action to be taken in areas identified in the body of this report. No requirements were made at this inspection. Key inspection report CARE HOMES FOR OLDER PEOPLE Longlands Balfour Road Blackbird Leys Oxford Oxfordshire OX4 6AJ Lead Inspector Marie Carvell Key Unannounced Inspection 14th August 2009 11:37 DS0000013158.V376355.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longlands Address Balfour Road Blackbird Leys Oxford Oxfordshire OX4 6AJ 01865 779224 01865 774769 manager.longlands@osjctoxon.co.uk www.osjct.co.uk The Orders Of St John Care Trust Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sharon Donna Fenn Care Home 47 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only – (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical disability (PD) 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 47. Date of last inspection 14 th August 2007 Brief Description of the Service: Longlands is a care home providing personal care and accommodation for 47 older people. It is located on the outskirts of the city of Oxford in the centre of a housing estate and close to many amenities. The care home is managed by The Orders of St John Care Trust who are responsible for many care homes throughout Oxfordshire, Wiltshire, Lincolnshire and Gloucestershire. The home is a two-storey building with a passenger lift. All bedrooms are for single occupancy and have shared bathroom facilities. There is a large dining room with a bar and seating area at one end, and four other sitting rooms. There is a pleasant courtyard garden that is safe and accessible to service users. The current range of fees is from £ 533.00 per week to £700 per week. Items not covered within fees include hairdressing, chiropody, newspapers, toiletries and contribution to some outings and activities. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection of the service was an unannounced ‘key Inspection’. We (the commission) arrived at the service at 11:00 and were in the service until 18:00. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager Sharon Fenn in June 2009 and any other information that we have received about the service since the last inspection. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. We toured communal areas of the home, examined a sample of records required to be kept in the home, including the case tracking of a sample of service user records and staff personnel records, we spent time talking to service users in communal areas of the home and in private. We also spent time talking to the manager, staff on duty and briefly with the area operations manager. In addition we observed how care was being delivered to service users and joined service user for the midday meal. What the service does well: Prospective service users and their representatives are encouraged to visit the home before making a decision to move into the home for a trial period. The healthcare needs of service users are fully met. Service users were clear about the complaints procedure and said that they would speak to the manager or the person in charge at the time. Recruitment procedures are robust. Staff are well trained and are able to carry out their roles with confidence. The home is run in the best interests of the service users. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are assessed prior to admission to ensure that their needs can be effectively met by the home. EVIDENCE: All prospective service users are provided with information about the home, including a copy of the home’s most recent inspection report. Oxfordshire County Council has a block contract with the home for thirty eight of the forty seven beds. Service users confirmed that they had received enough information about the home before moving in for a trial period. Several service users confirmed that they or a family member were able to visit the home to look at the accommodation and facilities available. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 9 The manager or head of care carry out a pre- admission assessment of all prospective service users to ensure that the home is able to meet their assessed needs. This is well documented on service user files. All service users are provided with a contract/terms and conditions. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans need to be in sufficient detail regarding lifestyle choices and the preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed in include how the emotional, psychological and social care needs of each service user is identified and met. The healthcare needs of service users are fully met. Medication administration, recording and storage are maintained to a high standard. Service users feel that they are treated with dignity and respect. EVIDENCE: Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 11 Care plans are drawn up from the pre- admission assessment, agreed and signed by the service user and/or their representative as appropriate. Information regarding health and personal care is well documented. However, care plans do not evidence how the service users emotional, psychological or social care needs are identified and met. Care plans are not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided and when, this was discussed in detail with the manager, Sharon Fenn. This is currently being addressed by the Trust. Service users were observed to be well groomed and appropriately dressed, a hairdresser visits the home weekly and this is appreciated. Attention is given to ensuring that service users have their spectacles, dentures and hearing aids in place. The healthcare needs of service users are met by eight GP practices, as service users are able to remain with their doctor. The manager said that this didn’t cause any difficulties as two practices have the majority of service users. District nurses visit the home on a regular basis and other healthcare professionals visit as required. From discussion with the manager, service users and evidence seen the healthcare needs of service users are fully met. Medication is administered by care staff who have completed medication training and are required to complete an annual competency check. The manager undertakes monthly medication audits. Two areas were identified as requiring attention, one that PRN ( when required) medication should be supported by a care plan and it was observed that a master key was being used to open all medication cabinets, including the two medication trolleys and controlled drug cabinet. Immediate action was taken to address this. Staff were observed to interact with service users in a calm, respectful and kind manner, this was confirmed in discussion with service users. Service users expressed their satisfaction of the care provided, the accommodation and facilities made available. One service user said that he/she would like to be able to have more than one bath per week and when this had been requested had been told that the home was short of staff. This was discussed with the manager, following the inspection we received an action plan from the manager who confirmed that she had found no evidence to suggest that service users are only given one bath per week, if the home is short of staff and service users can have more than one bath is requested. This information needs to be included in individual personal care plans. A service user admitted for respite care told us that when at home she was able to bath herself as he/she had aids to assist with independence and the day after arriving in the home, two care assistants gave her a bath, although not requested. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff team compared with the current service users. From discussion with the manager and observation, we consider Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 12 that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are encouraged to exercise choice and control over their daily lives. A range of activities and community involvement is available to meet the social needs of the service users. The manager is to review how the views of service users are sought and meal times in the home. EVIDENCE: The home employs an activity organiser for twenty five hours per week. These hours are flexibly used to cover evening and week end activities. At the last inspection a good practice recommendation was made that the manager should consider designating a named carer to be responsible for organising activities when the activity organiser is not in the home, the manager Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 14 confirmed that this had been put into place. Information regarding events, activities and outings are displayed. Although a wide range of activities take place, it is not evidenced from information recorded in care plans or daily records. The manager confirmed that the new care planning documentation will address this. Service users expressed their satisfaction of activities provided and described the volunteer who had visited the home during the morning to provide hand massages as “very relaxing”. Many service users said that they preferred to just sit quietly and didn’t take part in any activities. Volunteers from local churches visit the home and provide transport to Sunday worship. Many of the service users have friends and family members who are able to visit on a regular basis. Service users are encouraged to maintain local links, as far as possible with the local community. Service user meetings are held on a regular basis and service users confirmed that the manager is always available for a chat. At the last inspection a good practice recommendation was made that the manager should consider how best to organise the service user meetings, to better meet the wishes of the individuals living in the home. The manager confirmed that this had been put into place. The manager confirmed that she is to hold smaller meetings with service users as large groups make it difficult for some service users to hear or understand what is being said. Service users confirmed that routines are generally flexible in the home, such as being able to decide how they spend their day, when to go to bed or when to get up. We joined service users for the midday meal. The menu was displayed and demonstrated a choice of main course. Service users said that the food was good and there was always a choice. Service users were assisted as necessary in a dignified manner. At the last inspection a good practice recommendation was made that the views of people living at the home should be sought about how to improve the evening meal. The manager confirmed that this had been addressed and related to the choice of dishes served. Following comments made by service users about the timing of the teatime meal served at 4.30 pm, following the midday meal served at 12.30, the manager has agreed to conduct a survey among service users to find out about their preferred meal times. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are confident that any concerns or complaints will be taken seriously, listened to and acted upon. Policies and procedures are in place to protect service users from possible abuse. EVIDENCE: The home’s complaints procedure is displayed in the entrance hall. In the last twelve months the home has recorded five complaints received either verbally or in writing. All were seen to be appropriately documented with action taken and outcomes clearly recorded. Service users were clear about the complaints procedure and said that they would speak to the manager or the person in charge at the time. All staff receive training in safeguarding vulnerable adults from abuse procedures including whistle blowing, during their induction and then updated regularly, this is evidenced in training records. In discussion with staff on duty all were clear about the procedures. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 16 No safeguarding adult referrals or safeguarding adult investigations have taken place in the last twelve months. No referrals have been made for inclusion on the protection of vulnerable adults list (POVA). Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe, well maintained and comfortable accommodation. EVIDENCE: The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of being able to personalise their own bedrooms and the facilities available. All bedrooms are single occupancy and there are sufficient numbers of bathrooms and toilets throughout the home. Communal areas of the home have been made comfortable and have a homely feel. There is a programme of redecoration and refurbishment in progress. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 18 Some sluice facilities and bathrooms have been updated. It was noticed that a number of cupboards, in communal areas of the home, were secured with padlocks. This was discussed with the manager, who agreed to arrange for more appropriate locks to be fitted. All areas of the home were seen to be clean. One area of the home had a strong odour of stale urine; the manager was unaware of this, but confirmed by the area operations manager. Following the inspection we received an action plan from the manager confirming that she had discussed the cleaning routine with staff and had reviewed cleaning materials used. A plan had been put into place to increase the frequency of cleaning and install another air freshener. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear to be adequate to meet the needs of the service user. Recruitment procedures are robust. Staff are well trained and are able to carry out their roles with confidence. EVIDENCE: From discussion with the manager, staffs on duty, examination of duty rosters and observation, staffing levels appear to be adequate to meet the needs of the service users. The home benefits from a low turnover of staff and during the last twelve months four members of staff have resigned for a variety of reasons. The home is currently fully staffed. In June 2009, the staffing levels increased to three waking care staff on duty at night. Members of staff are encouraged to undertake national vocational qualification training (NVQ). Currently of the thirty permanent care staff, twenty two have achieved NVQ at levels II or III. The remaining care staff have been nominated and are waiting to start the training. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 20 From examination of a sample of staff personnel records, the home’s recruitment procedures are robust. The home has a training and development programme in place. All staff undertake induction training, appropriate to their role once in post, then are required to complete mandatory training and specialist training, as appropriate. This is well organised and documented. Staff spoken to expressed their satisfaction of working in the home, said that they felt valued and well supported by the manager and the Trust. Staff were observed to be carrying out their duties in a confident and professional manner. From discussion with the manager and staff on duty we consider that morale in the home is good. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by an experienced and qualified manager. EVIDENCE: The manager Sharon Fenn was registered with the commission in September 2009 and is an experienced and qualified manager. She is supported by a head of care, a team of four care leaders and an experienced administrator. Service users and members of staff expressed the opinion that the home is well managed and run in the best interests of service users. Service users said Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 22 that Sharon Fenn was “always available for a chat”, “very pleasant and kind” and “nothing is too much trouble”. Staff described Sharon Fenn as “having high standards”, “service users are her main priority” and “fair and approachable”. Policies and procedures are in place and reviewed on a regular basis. Procedures for dealing with service users’ monies and valuables are well maintained in line with Trust policies and are audited annually. All care staff receive formal 1-1 supervision at least six times per year, in line with the Trust policies. Reports written by a provider representative, following a monthly unannounced visit to the home, were available for examination. Quality assurance systems are in place and are undertaken annually and monthly audits take place. Evidence was seen to demonstrate that the views of service users, their representatives and staff are used to measure the home’s success in meeting the aims, objectives and statement of purpose. A sample of records relating to health, safety and welfare were examined and found to be well maintained and up to date. It was noted that hot water temperatures for bathing are recorded as below the recommended safe hot water temperatures of 43c. Following the inspection we received an action plan from the manager confirming that she had booked an engineer to visit the home the following week to rectify the water temperatures. Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Longlands DS0000013158.V376355.R01.S.doc Version 5.2 Page 25 Care Quality Commission Hermatige Court Hermatige Lane Maidstone Kent ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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